2025 SCHOLARSHIP SWIM LESSONS REGISTRATION

Registration is limited to those who are approved for the scholarship swim lesson program.  To sign up for this, the enrollment form can be found below.

2025 Scholarship Swim Lessons

Ben Franklin Scholarship Swim Club Lessons

"*" indicates required fields

Parent's Name*

First Last

Parent's Phone*

Parent's Email*

Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Child's Name*

First Last

Child's Gender*

Female

Male

Child's Date of Birth*

MM slash DD slash YYYY

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